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Twenty years ago, we sat around the television and watched what we thought would be the future of medicine: a bionic man who was fitted with high-tech parts when his natural parts failed. We saw a world where we could rebuild people, making them faster, stronger, and better than they were before.

But things didn't quite work out that way. Artificial limbs have come a long way, yet they won't provide superhuman strength. And we still can't restore eyesight, let alone create X-ray vision. But in many ways, we've outdone "The Six Million Dollar Man": New technologies have made it possible to build and implant all manner of lifesaving devices and to perform operations in far less invasive ways.

Many of the most exciting breakthroughs are still in the labs or undergoing trials, but doctors are using others in their offices and operating rooms. These advances are helping us live richer, fuller, and longer lives. But for all the breathtaking advances in health care, many questions remain unanswered: How do we ensure that all patients have access to the latest techniques and innovations? How do we use these advances to detect and prevent diseases? Here, too, technology may hold the answers.

Consider laparoscopy, a revolutionary surgical technique that uses a telescope rod (called an endoscope) with a tiny camera to perform major operations without major incisions. Since the first laparoscopic procedurea gallbladder removal from a patient in Germany in 1985such surgeries have mushroomed both in popularity and complexity.

Now performed at hospitals throughout the U.S., advanced laparoscopy is used to remove kidneys, intestines, and entire stomachs. Because several tiny incisions are madeeach about the size of a dimepatients are spared long hospital stays and huge bills. "There's a quicker recovery time, less chance of infection, and less hospital time," says Dr. Butch Rosser, associate professor of surgery at the Yale University School of Medicine and director of the Yale Endo-Laparoscopic Center. "We can do most things now without opening the patient," says Rosser.

Here's the catch: Only 15 percent of surgeons are proficient in laparoscopy, which means that many patients don't have access to it. "We have to help empower the other 85 percent," says Rosser. Here again, technology is proving essential, allowing skilled surgeons to telementor colleagues until they are up to speed. From his Connecticut office, Rosser has watched live video from an endoscopic camera in an operating room in the Dominican Republic, guiding the on-site surgeon step by step.

Telementoring just scratches the surface of how technology is improving health care. Rosser is spearheading a project called Operation Beating Heart, which screens school athletes for potential heart problems. Trainers scan students with portable 5-pound ultrasound devices and transmit results directly to a cardiologist's wireless PDA. The specialist analyzes the data and gives an immediate thumbs up or thumbs down. "For eons, health care delivery has been based on the premise that people have to come to health care," says Rosser. "Now health care can come to the people."

For some of the most compelling advances, however, patients will still need to go to a top-flight medical center. At Brigham and Women's Hospital in Boston, a surgical navigation system lets neurosurgeons superimpose three-dimensional images of brain structures directly on the head of a patient, so doctors can peer inside the patient before they make an incision. And a robot called the da Vinci Surgical System, developed by Intuitive Surgical, lets surgeons in about 70 hospitals worldwide operate without touching patients. From a console, they watch video images from inside the patients and move handles that control surgical instruments. The system compensates for hand tremors, allowing an unprecedented level of precision.

Medical technology is enabling doctors not only to fix the parts that aren't working but replace them altogether. The artificial heart has come a long way since it was implanted 20 years ago in Seattle dentist Barney Clark. That heart, the Jarvik-7, was connected to an external generator the size of a refrigerator. Clark, who lived for 112 days with the new heart, had to be tethered to the generator. The connecting wires required openings on his skin, increasing the chance of infection.

Breakthroughs in miniaturized electronics and high-capacity batteries have brought about a whole new kind of artificial organone that incorporates its own power source. The AbioCor Implantable Replacement Heart, from Abiomed, uses a lithium battery to power the 2-pound thoracic unit that pumps the blood. The battery is constantly charged by an external power pack that is worn on the patient's waist. Thanks to transcutaneous energy transmission, there's no need for any wires to pass through the skin.

At the University of Illinois at Chicago, researchers have developed another life-saving device: an implantable capsule for diabetics, which releases a steady stream of insulin into the bloodstream. Because the capsule contains insulin-producing cells that would otherwise be attacked by the recipient's own immune system, engineers had to develop some way of letting the insulin out of the capsule while also keeping the patient's antibodies out.

The answer: A silicon membrane made with photolithographic techniques used in making computer chips. The pores of the membrane are so small that they let insulin escape while blocking antibodies.

At the Georgia Institute of Technology/Emory Center for the Engineering of Living Tissues, scientists are going even farther, working on synthetic blood vessels that could be used in bypass operations and on artificial pancreases.

Not every advanced device is designed for implantation. Indeed, one novel new device helps patients avoid costly implant surgery. The FDA recently approved the first wearable defibrillator: the 3-pound Lifecor WCD, a device that monitors a heart's rhythm and zaps it when a potentially dangerous irregularity is picked up.

The wearable defibrillator points to another benefit that technology is bringing to health care: the ability to collect data about our bodies so that researchers can better understand diseases. Lifecor's device records a host of heart information, which can then be sent via modem to a Web site where the patient's cardiologist can log on and review it. "By gathering all this data, we may be able to unlock some of the predictors for sudden cardiac arrest," says Kathleen Higgs, vice president of sales and marketing at Lifecor. "Scientists have been chasing something like this for a long time."

Patients have also been chasing something for a long time: the ability to learn more about their own medical problems. Thanks to the Web, health care information is now freely available on sites such as InteliHealth and MedicineNet.com, which offer everything from extensive libraries of medical research to information on clinical trials. Most important, technology is enabling those with diseasesand those caring for themto join communities, finding support and comfort at life's most difficult moments.

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